Provider Demographics
NPI:1295703999
Name:HENTEK, VIERA (MD)
Entity type:Individual
Prefix:MRS
First Name:VIERA
Middle Name:
Last Name:HENTEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 76TH ST
Mailing Address - Street 2:M2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2147
Mailing Address - Country:US
Mailing Address - Phone:212-879-3441
Mailing Address - Fax:212-879-2063
Practice Address - Street 1:205 EAST 76TH ST
Practice Address - Street 2:M2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-879-3441
Practice Address - Fax:212-879-2063
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS134136208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01723284Medicaid
NY01723284Medicaid
44A151Medicare ID - Type Unspecified